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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157208826
Report Date: 03/12/2025
Date Signed: 03/12/2025 01:47:07 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/13/2024 and conducted by Evaluator Shawna Doucette
COMPLAINT CONTROL NUMBER: 24-AS-20241213102753
FACILITY NAME:SHERWOOD ELDERLY CARE FACILITYFACILITY NUMBER:
157208826
ADMINISTRATOR:BARAJAS, JUDITHFACILITY TYPE:
740
ADDRESS:2204 SHERWOOD AVETELEPHONE:
(661) 220-6647
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93304
CAPACITY:6CENSUS: 5DATE:
03/12/2025
UNANNOUNCEDTIME BEGAN:
12:02 PM
MET WITH:Caregiver Roxana AguirreTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff handled resident in a rough manner
Staff spoke inappropriately to resident
Facility has inadequate food service for the residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit and was granted entry by Staff Roxana Aguirre. LPA explained the purpose of the visit. LPA contacted Administrator Judith Barajas via telephone who responded to assist with the visit.

LPA interviewed resident and staff. LPA interviewed R1's responsible party. LPA reviewed Hall ambulance records and resident records. Facility did not have a hospice care plan for R1. R1's 602 did not list primary or secondary diagnosis.

Based on interviews conducted faciity staff did not handle resident in a rough, speak inappropriately to resident or have inadequate food service for residents in care. It is undetermined if there was a time any of these allegations occurred.

Based on Hall ambualnce records review, there was not any documentation regarding the above allegations.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 24-AS-20241213102753
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: SHERWOOD ELDERLY CARE FACILITY
FACILITY NUMBER: 157208826
VISIT DATE: 03/12/2025
NARRATIVE
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Based on record reviews and interviews, Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

A copy of this report was provided.
SUPERVISOR'S NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2